When your networks are rooted in a community with lots of uninsured people, you'll find you bear many of the social costs -- even if you have insurance yourself.
Yesterday I wrote a post
showing how ostensibly color-blind policy can disproportionately hurt people of color (for lack of a better term) or not benefit them as much as it should. I argued this by pointing out that black and brown people will make up a disproportionate number of those people who will not gain any insurance from Obamacare. That is because Medicaid is administered through the states, and the Supreme Court ruled that that states have the right to refuse Medicaid expansion. The result is not simply a disproportionate number of black and brown people left uninsured, but, in some states, a situation where an actual majority of the uninsured are black and brown.
The effect is much worse when you consider that the African-American community is hyper-segregated highly segregated. You have to imagine a state like Mississippi, where the majority of the uninsured are going to be black and the black uninsured will be then mostly concentrated in black neighborhoods. In other words it will be other black people -- uninsured and not -- who will bear the entire social costs of this.
Here is one way to think about this: You are black. You have gotten your college degree and a decent job. But your younger brother isn't doing so well in school and needs some tutoring. And you're worried about your grandmother because her neighborhood isn't safe. And your homeboy, whom you were raised with, just finished a bid for intent to distribute. And your homegirl had a kid when she was 15, but the father is out.
You have made it out of a poor community, but your network is rooted there and shows all the markers of exposure to poverty. Because of a history of American racism, your exposure will be higher than white people of your same income level. Perhaps you would like to build another network. That network, because of a history of racism, will likely be with other black people -- black people who, like you, are part of a network that, on average, shows greater exposure to poverty. Meanwhile, white people are building other networks that are significantly less compromised by exposure to poverty.
This is how segregation compromises the power of black community. It takes a societal ill -- say a lack of insurance -- and then concentrates it one community. Members of the whole community, uninsured and not, feel the effects of this to varying degrees, and a problem that is truly American somehow becomes "black." The black uninsured of Mississippi -- a majority of the uninsured of the state -- are not going to be evenly distributed among the various networks of the state. They are going to be concentrated in one particular network.
What the state won't cover, private citizens must. Those citizen will tend to be black. The people who will have to drain their savings will be black. The people who will take out second mortgages will be black. The people who will pick up second jobs (if they can even get them) and miss parenting time will be black. You can multiply this out across social policy, and see how a wealth gap might be perpetuated. No fried chicken jokes required.
How does such a policy come to be? Whom should we blame? Here is one objection worth considering
I still don't understand how the health law illustrates a shortfall of "color-blind" policies targeting the poor. The demographic numbers in the article show that when Obamacare more generally targeted poor people, it was hugely beneficial to blacks and Latinos. It was only when the Supreme Court shifted it from "lift all boats" to letting states decide whether to lift or sink all boats, did people of color start getting screwed.
In other words, Obamacare doesn't show that black and brown people will be disproportionately among the screwed over when policies "simply target the poor"-- it shows black and brown people will be disproportionately among the screwed over when policies shift power to the states.
I think we need to be clear about a few things. Policy does not end after the president signs the law. The courts are part of policy. Brown v. Board struck down segregate schooling. That is part of policy. Plessy v. Ferguson laid the groundwork for Jim Crow. That was policy. So the Supreme Court decision to give states an out is not some separate deux ex machina. This is part of the process, and lawmakers constantly think about, and strategize around, how they believe the courts will see their actions.
The second thing we need to be clear on is that, in our system, the interests of the states have always played an integral role in how we set social policy, often to the detriment of black people. Ira Katznelson's book When Affirmative Action Was White has a brilliant chapter on how the G.I. Bill -- a colorblind, "lift all boats" policy -- actually perpetuated the wealth gap. How was this accomplished? Here is Katznelson:
To be sure, as a national program for all veterans, the GI Bill contained no clauses directly or indirectly excluding blacks or mandating racial discrimination. Even the NAACP's director of the Office of Veterans Affairs, Frank Dedmon, believed that "the VA administers the law as passed by Congress to both Negro and White alike."59 But it was, as Frydl acutely observes, "a congressionally federalized program -- one that was run through the states, supervised by Congress; one central policy making office and hundreds of district offices bounded, in a functional as well as political way, by state lines."
Operating in this manner, she notes, the "exclusion of black veterans came through the mechanisms of administration," and this "flexibility that enabled discrimination against black veterans also worked to the advantage of many other veterans." In this aspect of affirmative action for whites, the path to job placement, loans, unemployment benefits, and schooling was tied to local VA centers, almost entirely staffed by white employees, or through local banks and both public and private educational institutions. By directing federal funding "in keeping with local favor," the veteran status that black soldiers had earned "was placed at the discretion of parochial intolerance."
We should understand where the G.I. Bill stands in the American imagination. Bill Clinton calls it "raised the entire nation to a plateau of social well being never before experienced in U.S. history." It is also a law that Katznelson persuasively argues "widened the country's wealth gap."
I'd be shocked if Obamacare did that, and I don't think it will -- at least not nationally. But my point is that the problems of ostensibly "racism-free" policy devolving into something else is not unique to Obamacare, nor unique to Barack Obama -- and those problems, themselves, are not "racism-free." You can't understand a "states' rights" solution without understanding slavery, Jim Crow and the actual implementation of the New Deal. There are probably very good political reasons -- necessary reasons, even -- for why we attempted to expand insurance through Medicaid. But unless we do something radically different, those reasons will always be dogged by the racism which extends from our roots to our leaves.
And you need not be a "bad person" for this to take effect. All you need do is hold to a religion of "lifting all boats" and ignore the actual science of the sea. All you need do is start paying your taxes under the belief that this will make your prior years, and the interest accrued, magically disappear.